中国骨与关节外科
中國骨與關節外科
중국골여관절외과
CHINESE BONE AND JOINT SURGERY
2013年
5期
421-426
,共6页
周磊%李涛%翁习生%蒋超%翟吉良%彭慧明
週磊%李濤%翁習生%蔣超%翟吉良%彭慧明
주뢰%리도%옹습생%장초%적길량%팽혜명
氨甲环酸%meta分析%全髋关节置换术%失血%异体输血
氨甲環痠%meta分析%全髖關節置換術%失血%異體輸血
안갑배산%meta분석%전관관절치환술%실혈%이체수혈
tranexamic acid%meta analysis%total hip arthroplasty%blood loss%allogeneic transfusion
背景：目前针对氨甲环酸（TXA）能否安全有效地降低全髋关节置换术（THA）的失血量和输血率尚未达成共识。目的：通过meta分析评价TXA在THA围手术期应用的有效性和安全性。<br> 方法：检索2003年至2013年PubMed、Medline、EMBase、Cochrane library、CNKI和万方数据知识服务平台中发表的有关TXA在THA中应用的相关临床随机对照研究，对TXA组与对照组术中失血量、术后失血量、总失血量、异体输血率及静脉血栓栓塞症（VTE）发生率进行meta分析。<br> 结果：筛选出符合纳入标准的高质量随机对照研究9篇，共460例（460髋）。与对照组比较，TXA可减少THA患者的术中失血量[WMD=-87.04,95%CI（-148.54,-25.55）, P=0.006]，术后失血量[WMD=-123.35,95%CI（-215.04,-31.66）, P=0.008]，总失血量[WMD=-247.74,95%CI（-350.60,-144.89）, P＜0.00001]，降低输血率[OR=0.34,95%CI（0.21,0.55）, P＜0.0001]，而VTE发生率无明显差异。<br> 结论：TXA可明显减少THA围手术期失血量，降低输血率，同时不增加发生VTE的风险。
揹景：目前針對氨甲環痠（TXA）能否安全有效地降低全髖關節置換術（THA）的失血量和輸血率尚未達成共識。目的：通過meta分析評價TXA在THA圍手術期應用的有效性和安全性。<br> 方法：檢索2003年至2013年PubMed、Medline、EMBase、Cochrane library、CNKI和萬方數據知識服務平檯中髮錶的有關TXA在THA中應用的相關臨床隨機對照研究，對TXA組與對照組術中失血量、術後失血量、總失血量、異體輸血率及靜脈血栓栓塞癥（VTE）髮生率進行meta分析。<br> 結果：篩選齣符閤納入標準的高質量隨機對照研究9篇，共460例（460髖）。與對照組比較，TXA可減少THA患者的術中失血量[WMD=-87.04,95%CI（-148.54,-25.55）, P=0.006]，術後失血量[WMD=-123.35,95%CI（-215.04,-31.66）, P=0.008]，總失血量[WMD=-247.74,95%CI（-350.60,-144.89）, P＜0.00001]，降低輸血率[OR=0.34,95%CI（0.21,0.55）, P＜0.0001]，而VTE髮生率無明顯差異。<br> 結論：TXA可明顯減少THA圍手術期失血量，降低輸血率，同時不增加髮生VTE的風險。
배경：목전침대안갑배산（TXA）능부안전유효지강저전관관절치환술（THA）적실혈량화수혈솔상미체성공식。목적：통과meta분석평개TXA재THA위수술기응용적유효성화안전성。<br> 방법：검색2003년지2013년PubMed、Medline、EMBase、Cochrane library、CNKI화만방수거지식복무평태중발표적유관TXA재THA중응용적상관림상수궤대조연구，대TXA조여대조조술중실혈량、술후실혈량、총실혈량、이체수혈솔급정맥혈전전새증（VTE）발생솔진행meta분석。<br> 결과：사선출부합납입표준적고질량수궤대조연구9편，공460례（460관）。여대조조비교，TXA가감소THA환자적술중실혈량[WMD=-87.04,95%CI（-148.54,-25.55）, P=0.006]，술후실혈량[WMD=-123.35,95%CI（-215.04,-31.66）, P=0.008]，총실혈량[WMD=-247.74,95%CI（-350.60,-144.89）, P＜0.00001]，강저수혈솔[OR=0.34,95%CI（0.21,0.55）, P＜0.0001]，이VTE발생솔무명현차이。<br> 결론：TXA가명현감소THA위수술기실혈량，강저수혈솔，동시불증가발생VTE적풍험。
Background:Whether or not tranexamic acid (TXA) can effectively and safely reduce blood loss and allogeneic transfusion in total hip arthroplasty (THA) has not yet reached a consensus. <br> Objective:To assess the efficacy and safety of TXA administration during THA through meta analysis. <br> Methods:Clinical randomized controlled trials (RCTs) concerning TXA application in THA published from 2003 to 2013 were retrieved from the PubMed, Medline, EMBase, Cochrane library, CNKI and WanFang databases. A meta-analysis was conducted to evaluate intraoperative blood loss, postoperative blood loss, total blood loss, allogeneic transfusion and venous thromboembolism (VTE) in TXA-treated group versus control group. <br> Results:Eventually 9 high-quality RCTs including 460 patients (460 hips) were chosen for the meta-analysis. Compared with control group, TXA significantly reduced intraoperative blood loss [WMD=-87.04, 95%CI(-148.54,-25.55), P=0.006], postoperative blood loss [WMD=-123.35, 95%CI(-215.04,-31.66), P=0.008], total blood loss [WMD=-247.74, 95%CI(-350.60,-144.89), P<0.00001] and proportion of patients requiring allogeneic transfusion [OR=0.34, 95%CI(0.21, 0.55), P<0.0001]. But there was no significant difference in the incidence of VTE between TXA-treated group and control group. Conclusions:TXA can significantly decrease perioperative blood loss and allogeneic transfusion during THA and will not raise the risk of VTE.
